癥狀性椎動脈顱內(nèi)段狹窄的臨床分析
發(fā)布時間：2019-03-17 18:48
【摘要】：目的： 探討癥狀性椎動脈顱內(nèi)段(ICVA)狹窄的臨床特點、影像學(xué)特征、治療方法及預(yù)后。 方法： 2014年1月至2015年3月在我院神經(jīng)內(nèi)科住院治療的10例癥狀性ICVA狹窄患者,分析其相關(guān)的臨床資料及治療經(jīng)過,并進(jìn)行隨訪觀察。所有患者住院期間均完成頭顱磁共振成像(MRI)、數(shù)字剪影血管造影(DSA)和經(jīng)顱多普勒超聲(TCD)檢查。根據(jù)腦血管檢查結(jié)果,對10例患者ICVA病變的特點進(jìn)行分析,并探討ICVA病變與臨床表現(xiàn)、治療、預(yù)后的關(guān)系。 結(jié)果： 10例患者中,男性8例,女性2例,平均年齡(60±9.24)歲,6例診斷為后循環(huán)短暫性腦缺血發(fā)作(TIA),4例為后循環(huán)缺血性卒中；高血壓8例,糖尿病4例,高同型半胱氨酸血癥3例,血脂障礙2例,吸煙4例,臨床癥狀主要為頭暈／眩暈、行走不穩(wěn)、言語不利和肢體麻木無力。10例患者中單側(cè)ICVA狹窄6例,雙側(cè)ICVA均受累4例；6例患者同時合并頸部或其他顱內(nèi)動脈50%的狹窄,包括椎動脈起始部、大腦中動脈、頸內(nèi)動脈以及基底動脈；7例患者合并椎動脈優(yōu)勢。ICVA狹窄／閉塞的好發(fā)部位依次為遠(yuǎn)段(8/14)、近段(5/14)和中段(1/14)。4例腦梗死的患者中有3例為雙側(cè)ICVA病變,6例TIA的患者中有5例為單側(cè)ICVA狹窄。在單側(cè)ICVA狹窄的6例患者中,患側(cè)椎動脈血流速度減慢,收縮期血流速度均小于40cm/s,收縮期血流速度和平均血流速度顯著低于健側(cè)(P0.05),血管搏動指數(shù)顯著高于健側(cè)(P0.01)。所有患者均在抗血小板治療的基礎(chǔ)上積極控制腦血管病危險因素,5例患者接受血管內(nèi)支架治療,操作均獲得成功且無圍術(shù)期并發(fā)癥發(fā)生。對10例患者進(jìn)行了平均(6.80±3.68)個月的隨訪,除1例腦梗死患者遺留中度殘疾外,余患者預(yù)后良好。所有患者均無新發(fā)卒中事件。 結(jié)論： 癥狀性ICVA狹窄患者的臨床癥狀缺乏特異性,常合并椎動脈優(yōu)勢和其他部位的狹窄與閉塞。動脈粥樣硬化引起的嚴(yán)重狹窄常見于ICVA的遠(yuǎn)段,雙側(cè)ICVA病變在腦梗死患者中更常見。TCD提示ICVA狹窄近端的血流呈低流速高搏動樣改變。大部分癥狀性ICVA狹窄患者的短期預(yù)后良好。
[Abstract]:Objective: to investigate the clinical features, imaging features, treatment and prognosis of symptomatic intracranial (ICVA) stenosis of vertebral artery. Methods: from January 2014 to March 2015, 10 patients with symptomatic ICVA stenosis were treated in our department of neurology. The clinical data and treatment process were analyzed and followed up. All patients underwent magnetic resonance imaging (MRI),) digital silhouette angiography (DSA) and transcranial Doppler ultrasound (TCD) during hospitalization. According to the results of cerebral vascular examination, the characteristics of ICVA lesions in 10 patients were analyzed, and the relationship between ICVA lesions and clinical manifestations, treatment and prognosis was discussed. Results: of the 10 patients, 8 were male and 2 were female, the mean age was (60 鹵9.24) years, 6 patients were diagnosed as transient ischemic attack of posterior circulation (TIA), 4 patients were diagnosed as posterior circulation ischemic stroke. There were 8 cases of hypertension, 4 cases of diabetes, 3 cases of hyperhomocysteinemia, 2 cases of dyslipidemia and 4 cases of smoking. The main clinical symptoms were dizziness / vertigo and unstable walking. In 10 cases, unilateral ICVA stenosis was found in 6 cases, bilateral ICVA was involved in 4 cases; Six patients had 50% stenosis of the neck or other intracranial arteries, including the origin of the vertebral artery, the middle cerebral artery, the internal carotid artery and the basilar artery. The main sites of stenosis / occlusion were distal segment (8 / 14), proximal segment (5 / 14) and middle segment (1 / 14). Of the 4 patients with cerebral infarction, 3 were bilateral ICVA lesions, and 3 of 4 patients with cerebral infarction were found to be bilateral lesions, and the most common sites of stenosis / occlusion were distal (8 / 14), proximal (5 / 14) and middle (1 / 14). Of the 6 patients with TIA, 5 had unilateral ICVA stenosis. In 6 patients with unilateral ICVA stenosis, the blood flow velocity of vertebral artery slowed down, systolic blood flow velocity was less than 40 cm / s, systolic velocity and mean blood flow velocity were significantly lower in the affected side than in the healthy side (P0.05). The pulsatile index of blood vessel was significantly higher than that of healthy side (P0.01). All patients actively controlled the risk factors of cerebrovascular disease on the basis of antiplatelet therapy, and 5 patients received endovascular stent therapy. All patients were successful and had no perioperative complications. Ten patients were followed up for an average of (6.80 鹵3.68) months. Except for one patient with cerebral infarction, the prognosis of the remaining patients was good except for one patient with moderate disability. There were no new stroke events in all patients. Conclusion: the clinical symptoms of symptomatic ICVA stenosis are not specific and often associated with vertebral artery dominance and stenosis and occlusion in other parts. Severe stenosis caused by atherosclerosis was common in the distal segment of ICVA, and bilateral ICVA lesions were more common in patients with cerebral infarction. It was suggested that the blood flow at the proximal end of ICVA stenosis showed a low flow rate and a high pulsation-like change. Most patients with symptomatic ICVA stenosis had a good short-term prognosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3
本文編號：2442591
[Abstract]:Objective: to investigate the clinical features, imaging features, treatment and prognosis of symptomatic intracranial (ICVA) stenosis of vertebral artery. Methods: from January 2014 to March 2015, 10 patients with symptomatic ICVA stenosis were treated in our department of neurology. The clinical data and treatment process were analyzed and followed up. All patients underwent magnetic resonance imaging (MRI),) digital silhouette angiography (DSA) and transcranial Doppler ultrasound (TCD) during hospitalization. According to the results of cerebral vascular examination, the characteristics of ICVA lesions in 10 patients were analyzed, and the relationship between ICVA lesions and clinical manifestations, treatment and prognosis was discussed. Results: of the 10 patients, 8 were male and 2 were female, the mean age was (60 鹵9.24) years, 6 patients were diagnosed as transient ischemic attack of posterior circulation (TIA), 4 patients were diagnosed as posterior circulation ischemic stroke. There were 8 cases of hypertension, 4 cases of diabetes, 3 cases of hyperhomocysteinemia, 2 cases of dyslipidemia and 4 cases of smoking. The main clinical symptoms were dizziness / vertigo and unstable walking. In 10 cases, unilateral ICVA stenosis was found in 6 cases, bilateral ICVA was involved in 4 cases; Six patients had 50% stenosis of the neck or other intracranial arteries, including the origin of the vertebral artery, the middle cerebral artery, the internal carotid artery and the basilar artery. The main sites of stenosis / occlusion were distal segment (8 / 14), proximal segment (5 / 14) and middle segment (1 / 14). Of the 4 patients with cerebral infarction, 3 were bilateral ICVA lesions, and 3 of 4 patients with cerebral infarction were found to be bilateral lesions, and the most common sites of stenosis / occlusion were distal (8 / 14), proximal (5 / 14) and middle (1 / 14). Of the 6 patients with TIA, 5 had unilateral ICVA stenosis. In 6 patients with unilateral ICVA stenosis, the blood flow velocity of vertebral artery slowed down, systolic blood flow velocity was less than 40 cm / s, systolic velocity and mean blood flow velocity were significantly lower in the affected side than in the healthy side (P0.05). The pulsatile index of blood vessel was significantly higher than that of healthy side (P0.01). All patients actively controlled the risk factors of cerebrovascular disease on the basis of antiplatelet therapy, and 5 patients received endovascular stent therapy. All patients were successful and had no perioperative complications. Ten patients were followed up for an average of (6.80 鹵3.68) months. Except for one patient with cerebral infarction, the prognosis of the remaining patients was good except for one patient with moderate disability. There were no new stroke events in all patients. Conclusion: the clinical symptoms of symptomatic ICVA stenosis are not specific and often associated with vertebral artery dominance and stenosis and occlusion in other parts. Severe stenosis caused by atherosclerosis was common in the distal segment of ICVA, and bilateral ICVA lesions were more common in patients with cerebral infarction. It was suggested that the blood flow at the proximal end of ICVA stenosis showed a low flow rate and a high pulsation-like change. Most patients with symptomatic ICVA stenosis had a good short-term prognosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3
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相關(guān)期刊論文 前2條
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